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... contract is responsible for processing claims for more than 6 million ... than 6 million members, the claims processing and financial management functions ... to an external vendor. The..
Job Information Humana Medicaid Associate Director, Compliance Nursing in Pittsburgh Pennsylvania Description The Associate Director, Compliance Nursing reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations ..
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Description Responsibilities The Associate Director for ACD Audit , at the director of the Director of Payment Integrity, will create and implement process improvement plans focused on the beneficiary and provider ..
... (ACD). The technician assists with claims review, provider record updates, and ... 30% Assist with submission of claims corrections and recoupments, while monitoring ... Qualifications 2 plus years of..
Description Responsibilities The Utilization Management Nurse 2 will be responsible for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism ..
Description Humana's Claims Cost Management (CCM) organization is ... support our efforts for ensuring claims payment accuracy, so that our ... that our members receive quality healthcare at an affordable..
Description Responsibilities The SIU and PPI Lab review team is seeking a Medical Coding Auditor with a special set of skills. This person will focus on coding and clinical review of ..
Description The Payment Integrity Professional 2 uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our ..
Description Responsibilities The Compliance Professional 2 has responsibilities for performing clinical audits on medical record documentation for quality and clinical compliance with contract requirements as outlined in the Autism Care Demonstration ..
